Senior External Audit Analyst (Hybrid)

CareFirst, Inc.; Baltimore (MD); On-site; USD 68,000 - 135,000; Full time

Job summary

CareFirst BlueCross BlueShield seeks an External Audit Analyst to plan, organize and manage external audit activities across group customer audits, regulatory examinations, investigations, surveys and inquiries.

The role requires 5 years of audit experience in healthcare or related fields, with strong analytical abilities and excellent communication to coordinate with auditors and CareFirst teams. The position emphasizes timely deliverables and effective action tracking.

Qualifications

• Proficient in quality audit processes and reporting requirements.
• Strong PC skills (Microsoft Outlook, Word, Excel, PowerPoint).
• Extensive analytical and problem solving skills.
• Demonstrated skills conducting problem-solving discussions to negotiate effective solutions to audit issues.
• Knowledge of all claims, service and enrollment processing systems.
• Excellent communication skills (verbal and written) with the ability to influence and effectively communicate with all levels of associates and management.
• Good working knowledge of mainframe programs.

Responsibilities

• Plan, organize and manage external audit projects of varying complexity and length.
• Concurrently oversee, coordinate and schedule multiple external audits or examinations to be conducted by auditors representing CareFirst groups or regulatory examiners.
• Act as the liaison between the external auditors and CareFirst operational areas.
• Initiate or maintain schedule for projects and project milestones.
• Track deliverables to facilitate timely completion of external audits.

Skills

Quality audit processes

MS Office proficiency

Analytical and problem solving

Effective written and verbal comms

Knowledge of claims processing systems

Mainframe knowledge

Education

Bachelor's Degree or equivalent

Tools

Microsoft Office Suite

Job description

Resp & Qualifications

PURPOSE: The External Audit Analystplans, organizesand manages CareFirst external audit activities (group customer audits, regulatory market conduct examinations, investigations, surveys and inquiries).

ESSENTIAL FUNCTIONS:

• Plan, organize and manage external audit projects of varying complexity and length. Concurrently oversee, coordinate and schedule multiple external audits or examinations to be conducted by auditors representing CareFirst groups or regulatory examiners. Act as the liaison between the external auditors and CareFirst operational areas. Initiate or maintain schedule for projects and project milestones. Track deliverables to facilitate timely completion of external audits.
• Define problems, collect and review data, establish facts, draw valid conclusions and make thoughtful recommendations. Use analytical and problem resolution skills and apply Continuous Quality Improvement principles to system, departmental, data and other relevant issues impacting audit and reporting requirements or performance.
• Communicate in clear and concise manner, prepare cohesive and comprehensive written memos, emails and audit report responses documenting observations and CareFirst position, scope, objectives, procedures, findings, recommendations, comparisons, impacts, risks and projections, often under strict timelines.
• Assist company operational teams and company management in addressing and resolving issues arising from external audits. Make recommendations for appropriate actions and follow-up reviews related to audit findings to ensure that the Company has successfully and consistently implemented corrective actions and performance tracking.
• Review audit rights, performance guarantees and other clauses that affect audit performance standards and perform thought leadership on impact on CareFirst. Understand the business environment and relate extensive knowledge of internal and external activities to trends identified within external audits. Act as a team leader for small projects or work groups through utilizing the ability to begin with a concept and develop or act upon it. May assist with special projects as requested.

QUALIFICATIONS:

Education Level: Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 5 years of audit experience, in operational or compliance audits, with 3 of those years in health care administration, claims, customer service, health policy or a related field.

Knowledge, Skills and Abilities (KSAs)

• Proficient in quality audit processes and reporting requirements.
• Strong PC skills (Microsoft Outlook, Word, Excel, PowerPoint).
• Extensive analytical and problem solving skills. Extensive analytical and problem solving skills.
• Demonstrated skills conducting problem-solving discussions to negotiate effective solutions to audit issues.
• Knowledge of all claims, service and enrollment processing systems.
• Excellent communication skills (verbal and written) with the ability to influence and effectively communicate with all levels of associates and management.
• Good working knowledge of mainframe programs.

Salary Range: $68,184 - $135,421

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

External Audit Coordination

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of theCompany to provide equal employment opportunities to allqualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.